Move over, unlisted vascular surgery code 37799! That’s what mechanochemical ablation (MOCA) codes 36473 and +36474 said when they became reportable CPT® codes on Jan. 1, 2017. Give your use of these new endovenous ablation codes a check-up with the four pointers below.
1. Read the Descriptors All the Way Through
Reading the descriptor is a pretty obvious first tip, but there’s a reason for that. Here are the descriptors:
- 36473 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated)
- +36474 (… subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)).
Just look at some of the fun facts you can learn:
- The codes apply to percutaneous services in an extremity
- Code 36473 is for the first vein, and +36474 is for one or more subsequent veins treated in that extremity
- The codes include all imaging guidance and monitoring.
2. Use the Code Only for the Intended Tech
What it is: These codes apply to “concomitant use of an intraluminal device that mechanically disrupts/abrades the venous intima and infusion of a physician-specified medication in the target vein(s),” according to CPT® guidelines.
That’s a mouthful. A device brand name you’ll see tied to MOCA is ClariVein®IC. In the procedure, the provider administers local anesthesia and inserts an infusion catheter with a special wire tip into the incompetent (varicose) vein. Remember that any imaging guidance used is covered under the surgical code. She attaches the catheter to a motor drive unit. The wire tip rotates quickly inside the vein and delivers the medicine the provider chooses.
What it is NOT: “Sclerosant injection by either needle or catheter followed by a compression technique is not mechanochemical vein ablation,” the CPT® guidelines state. Use 37799 (Unlisted procedure, vascular surgery) for catheter injection of a sclerosant without the accompanying mechanical disruption of the vein intima, which is the inner layer.
3. Be Sure You Get the POS Right
The fees vary considerably for these surgery codes depending on whether you’re reporting physician work in a facility or nonfacility setting. As the CPT® guidelines explain, supplies and equipment required are included in payment when performed in the office setting.
For 36473, the Medicare Physician Fee Schedule (MPFS) in Q2 of 2017 shows these national rates (meaning they’re unadjusted for geography):
- Facility rate $179.80
- Nonfacility rate $1,522.40.
That’s a whopping $1,342.60 difference that you don’t want to lose or have to repay because of a simple place of service (POS) mistake.
The fee difference for +36474 isn’t quite as exciting, but getting POS wrong would add up fast:
- Facility rate $90.08
- Nonfacility rate $278.86.
4. Think Twice Before Reporting E/M
Code 36473 has a global period of 000. Here’s the official definition for that indicator from Medicare, which makes it clear that an E/M on the same date usually isn’t payable: Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.
As an add-on code, +36474 has a global period of ZZZ, which means: The code is related to another service and is always included in the global period of the other service.
How About You?
Code 36473 has an MUE of 1 in Q2 2017. Has that caused issues for you?